Islamic Attire and Health

The majority of female Muslims worldwide, following the Islamic requirement of observing Hijab, wear some form of Islamic dress. This ranges anywhere from wearing a simple head covering, to the burqa (a form of "full hijab"), which covers almost all exposed skin.

Full hijab can consist of the following elements:

• Jilbāb; this refers to any long and loose-fitting coat or garment worn by women.
• Khimar; a scarf or wrap, often referred to simply as 'hijab', used to cover the head and neck.
• Niqāb; a piece of cloth which veils the face.

Some Muslim jurists regard the wearing of a niqab as wajib (mandatory), while others believe it is mustahab (favored by Allah).^[1]

There is concern among the medical community about some of the health effects of the extreme styles of Islamic dress, with the main issues arising from Vitamin D deficiency due to lack skin exposed to UV light. It has been established by credible scientific evidence that almost all women who observe the full hijab are chronically deficient in Vitamin D.^[2] Vitamin D is a vital nutrient and deficiency of this kind can lead to various diseases.

Vitamin D Deficiency

Vitamin D is fat soluble vitamin which is an essential nutrient for human health.^[3][4] Vitamin D is synthesised when ultraviolet rays from sunlight strike the human skin triggering a series of reactions, it is by this method that a vast majority of a persons daily intake of Vitamin D is produced. It is naturally absent in significant quantities in almost all food items commonly consumed, with a very few select foods containing appreciable amounts and very few consumer products being fortified with it.^[5]

The main role of Vitamin D in the body is to regulate the correct amounts of calcium present in the blood. This vitamin aids in the absorption of calcium to create healthy, strong bones. Insufficient amounts of Vitamin D leads to weak, brittle and misshapen bones; a condition known as osteomalacia in adults and rickets in children. Sufficient amounts of Vitamin D are also crucial in preventing fractures and osteoporosis in older adults.^[6]

Low levels of Vitamin D have also been linked to a whole host of devastating disorders including cardiovascular diseases, type 1 diabetes, multiple sclerosis and rheumatoid arthritis. There is also a strong association between deficiency in Vitamin D and an increased risk of developing several deadly cancers, including breast cancer.^[7]

The concern is not only towards the woman who chooses to observe the more covering forms of Islamic dress but also towards any potential children she may carry. Infants born to vitamin D deficient mothers have been found to suffer from an increased prevalence of seizures.^[8] If these children observe the full hijab in childhood, they run the risk of not reaching the height they would of otherwise reached if they were not vitamin D deficient.^[9]

Islamic Dress and Health

Since almost all the daily intake of Vitamin D is from sunlight, exposure there is significant concern for women who wear the burqa or "full hijab". This style of dress, leaving only a very small portion of skin around the eyes exposed, greatly reduces the surface area of the body which sunlight is exposed to and hence reduces the amount of Vitamin D synthesized. Such low rates of Vitamin D production will quickly exhaust the bodies excess emergency stores of Vitamin D contained in the fat and the person will likely go into a deficient state.

Due to this reason, serious vitamin D deficiency is wide-spread in many Muslim majority countries. A study performed by doctors at King Fahd University Hospital in Saudi Arabia, showed that out of all 52 women tested, all had seriously deficient levels of Vitamin D and were at risk of many serious health problems, despite living in one of the sunniest places on the planet.^[10] Furthermore, in a study undertaken in Jordan, 83.3% of women wearing the most covering style of Islamic dresses were found to be deficient in summer time. This is rather striking when compared to the fact only 18.2% of Jordanian men studied were found to be deficient.^[11] Jordan, like Saudi Arabia, holds the distinction of being one of the sunniest places on the planet, so the effect of wearing the burqa on Vitamin D levels and health is profound.

Effect of Ethnicity and Migration

There is also concern for the health of immigrants from Islamic majority countries, most of which are around the equator and receive the highest amount of sunlight of any place on earth. There concern arises when these women migrate to countries with lower amounts of sunlight throughout the year compared to their previous home country. Skin tone is darkest at the equator in response to the sunlight.^[12][13] Darker skin blocks out significantly more UV radiation and hence decreases Vitamin D production by an enormous amount (people with dark skin pigmentation may need 20 - 30 times as much exposure to sunlight).^[14] All these factors combined with the heavily covering Islamic dress create serious potential health concerns for Islamic migrants in countries away from the equator such as Canada, the United States, Europe and Australia.^[15][16]

This is further evidenced by numerous scientific studies. A study was undertaken in Dearborn, Michigan, the most-concentrated Arab-American settlement in the United States to assess the relationship between Vitamin D levels and Islamic dress choice in migrant Arab-American Muslim women. The average vitamin D level was found to be 4 ng/ml in veiled women who undertook no vitamin D supplementation and 7 ng/ml in women who wore the same style veil but chose to take supplements.^[17] The threshold for rickets and osteomalacia risk is 8 ng/ml and below; clinical deficiency is considered as anything below 16 ng/ml.^[18] This illustrates a very serious health risk for migrant Muslim women who immigrate to such countries and wear the burqa.

In the United Kingdom, cases of rickets have been rare until recently. Cases of the disease have increased dramatically due to the growing Muslim population.^[19][20][21]

Obesity

It has been noted that the observance of hijab, the garments and the traditions surrounding them, can discourage exercise both psychologically and practically.^[22][23] The style of dress can make it easy to hide the bloat of a large meal, and it can be physically restrictive for those who wish to exercise, especially outdoors where one has to be aware of the weather (if it is too hot or humid). In the West, where most indoor gyms are mixed-sex, exercise without Islamic dress can be very difficult for observant Muslim women, and some forms of Islamic dress can make playing almost any sport nearly impossible.^[22][23]

According to The Economist magazine’s world rankings, the countries with the highest obesity rates among women are Muslim countries^[22] (data from 1999-2003 show 8 of the top 10 to be Muslim majorities; Qatar, Saudi Arabia, Palestinian territories, Lebanon, Albania, Bahrain, Egypt, and the United Arab Emirates),^[24] and a 2006 study presented by Qatari expert Issam Abd Rabbu at the "Facts About Obesity" seminar, found that up to 70 percent of women living in the Gulf Arab states (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia and the United Arab Emirates) were overweight or obese.^[25] Dr. Abdul Rahman Musaiqir, head of the Arab Center for Nutrition at Bahrain University, has said the problem of obesity among women in the Gulf states is being disguised by their Islamic dress, and that obesity rates are much higher than in developed countries.^[26]

A 2011 study issued by the National Commercial Bank (NCB), Saudi Arabia’s largest bank, found that the number of Saudis suffering from high blood pressure, diabetes and obesity is increasing at an alarming rate, and a survey released by the Saudi Diabetes and Endocrine Association (SDEA) in 2010 showed that over 70 percent of the Saudi population are "alarmingly obese".^[27] Figures released by the Qatar Diabetes Association (QDA) state that 20% of the population has been diagnosed as diabetic in Qatar, and the disorder is affecting more and more children.^[23] Some of the health problems associated with obesity include; heart disease, high blood pressure, type 2 diabetes, painful wear and inflammation on weight-bearing joints, breathing problems and sleep apnea.^[28]

The observance of hijab prevents women from getting enough vitamin D. This can lead to a whole host of disorders. For Islam as a religion, the implications are troublesome.

Islam is considered by its adherents to be the perfect way of life for mankind. If Islam was mandated by Allah, and if he wanted women to observe hijab, then logically he would not have created humans with the need to get Vitamin D from exposing their skin to the sun.

It could be argued that today this can be combated with vitamin D supplementation combined with daily exposure to the sun in the privacy of ones backyard or some other location safe from the eyes of non-mahram men. However, this is not a satisfactory solution.

Many are not fortunate enough to have their own private gardens where they can sit, and sitting in front of a window inside their homes will not help because window glass only lets through UV-A rays, not UV-B and UV-C. You need UV-B rays for the production of vitamin D.^[29]

Furthermore, it was only in 1923 that it was established when 7-dehydrocholesterol is irradiated with light, a form of a fat-soluble vitamin is produced,^[30] and until the mid-1930s, when the first commercial yeast-extract and semi-synthetic vitamin C supplement tablets were sold, vitamins were obtained solely through food intake and (in the case of vitamin D) through exposure to the sun.^[31]

So what of the Muslim women prior to the 1930s and their vitamin intake? If this were a satisfactory explanation to avoid Islam contradicting modern scientific knowledge, then it would have been mentioned in the Qur'an or hadith literature, but it is not.

It could also be argued that long-term excessive exposure to UV radiation from sunlight can cause skin cancer and other ailments. However, according to epidemiologist Robyn Lucas at Australian National University,^[32] analysis of lifespan versus disease shows that far more lives are lost to diseases caused by lack of sunlight than by those caused by too much,^[33] and of course, a women is always capable of avoiding what she feels to be too much or too little sunlight, but with the restrictive Islamic dress laws in force, this ability is taken away from her.

• Hijab - A hub page that leads to other articles related to Hijab
• Health - A hub page that leads to other articles related to Health

• Women could endanger their health by wearing burqas - Digital Journal
• Addressing vitamin D deficiency among veiled pregnant women in Australia - Excerpt from 'Nutrition & Dietetics: The Journal of the Dietitians Association of Australia
• Middle Eastern women may have vitamin D deficiency - Reuters
• The consequences of Islamic dress - FFI Forum
• Synthetic Hijabs Get Under Tajik Women's Skin - Radio Free Europe/Radio Liberty
• Burqa-clad women prone to vitamin D deficiency: Doctors - The Times of India